Vitamin B12 Deficiency: Unveiling the Silent Culprit

Dr Ben Stride

The National Health Service (NHS) already bears a significant burden, but the responsibility of addressing vitamin B12 deficiency lies with the National Institute for Health and Care Excellence (Nice). As they finalize their inaugural formal guidance on diagnosing and treating this deficiency, it becomes apparent that B12 insufficiency is both common and frequently overlooked. The forthcoming Nice guidelines are expected to encourage broader testing and treatment, potentially benefiting countless individuals, including you.

Vitamin B12 plays a pivotal role in red blood cell production and the proper functioning of the brain and nervous system. When deficient, a myriad of symptoms can surface—ranging from fatigue, memory issues, and a sore tongue, to weakness, pins and needles sensations, and even more severe complications like anaemia, breathlessness, confusion, paralysis, or, in extreme cases, death. Unfortunately, B12 deficiency often develops gradually over years, and routine blood tests may not reveal the insufficiency unless specifically requested.

While B12 naturally occurs in animal products such as meat, fish, milk, and eggs, its absorption can be challenging. To maintain optimal levels, a balanced diet, healthy bowel, ample stomach acid, and the presence of a special protein called intrinsic factor (IF) are necessary. Unfortunately, millions in the UK struggle with one or more of these factors, placing them at risk.

Although B12 deficiency is more common among older individuals, it can affect people of all ages. While comprehensive UK data is scarce, international studies from the US and Netherlands suggest that approximately 1 in 30 young adults, 1 in 25 middle-aged individuals, and up to 1 in 5 people over 80 may be affected.

Certain groups face higher risks, such as vegans, among whom at least one in ten is believed to be deficient. For vegans, it's essential to take supplements or consume B12-fortified foods like certain plant-based milks, soy products, and cereals. Additionally, individuals with autoimmune conditions or a family history of B12 deficiency may face intrinsic factor disruptions, reducing absorption even with a good diet or supplementation. Moreover, medications like "antacids" and type 2 diabetes drug metformin can interfere with B12 absorption, and those with bowel problems, such as coeliac disease, may struggle to absorb nutrients effectively.

Diagnosing B12 deficiency relies on maintaining a high index of suspicion. Since the NHS cannot routinely screen the entire population through regular blood tests, diagnosis depends on recognizing symptoms or conducting tests for those at higher risk due to underlying health conditions.

Diagnosing B12 deficiency isn't always straightforward, and the approach to treatment varies. For most individuals, a standard NHS B12 blood test suffices, leading to either B12 injections or high-dose (1,000mcg) tablets, depending on individual circumstances, symptoms, and blood results. However, caution is advised, as resolving deficiencies with high-dose supplements for at least three months may lead to recurring issues unless dietary, medication, or underlying health condition changes occur. Many individuals may require lifelong supplements or regular testing to maintain optimal levels.

Due to NHS prescribing changes, some individuals with low B12 levels may be advised to purchase over-the-counter supplements instead of obtaining them through prescriptions. If this applies to you, consider opting for sublingual supplements designed to melt under your tongue or in your cheek, as they may aid absorption, particularly if you're on antacids, have low IF activity, or an underlying bowel problem.

Whatever the treatment path, the journey begins with a blood test, and the question arises—who should be tested?

For individuals diagnosed with B12 deficiency, the treatment path may differ, but the journey begins with a simple blood test. Once diagnosed, discussions with healthcare professionals will help determine the most suitable treatment option—whether it be B12 injections or high-dose tablets. The key is to address the deficiency promptly and consistently monitor your progress to ensure long-term health and well-being.

Vitamin B12 deficiency is a silent culprit that can manifest in a range of debilitating symptoms. The forthcoming formal guidance by the National Institute for Health and Care Excellence (Nice) is expected to raise awareness and promote wider testing and treatment. Whether you are a vegan, have an underlying health condition, or take specific medications, a high index of suspicion and regular blood testing are crucial in early detection and management of B12 deficiency.

Embrace your health and be proactive in safeguarding your well-being. Remember, the journey to optimal health begins with a simple blood test. Don't hesitate to seek medical advice if you suspect B12 deficiency, as timely intervention can make all the difference.